Behind the drama of the world's first heart transplant

It was an operation that earned him acclaim, but the world's first heart transplant also provoked hate mail and outspoken criticism of South African surgeon Christiaan Barnard, 50 years ago.

"We did not realise that it would take the public by storm and create such an outcry," says Dene Friedmann, a specialist nurse on the cardiovascular team, standing in the same Cape Town operating theatre where the medical feat took place.

Its watery-green tiled walls, visited by schools and the public, stir many memories for her of the historic procedure. And its aftermath.

"There were people who wrote quite critical letters to Professor Barnard, horrible letters calling him 'the butcher'," says Friedmann, now in her seventies.

The insults rained.

"I have heard of human vultures, but it is the first time I have saw one with a name on it," said one letter dated just one month after the operation and sent from Illinois in the United States.

"You had the audacity to assume the authority of God by pretending to become the giver of life," said another from Hong Kong.

The French magazine Paris Match summed up the ethical debate in a headline: "The battle of the heart. Do surgeons have the right?"

But the scientific community welcomed the technical advance -- the United States had also been seeking the accolade -- and ordinary citizens sent congratulations.

At the time the heart was not considered a mere organ -- it was more a symbol of deeper meaning, for some, the bringer and taker of life itself.

Unlike today, there was no common legal definition of brain death and the surgical team did not want to be accused of removing a beating heart to give it to another human.

There was also a political dimension, with South Africa's apartheid government delighted to have some good news.

"They used Professor Barnard as the ambassador for the country," recalls Friedmann.

'Empty chest'

It was on the first floor of Groote Schuur Hospital on December 3, 1967 that Louis Washkansky received the donor heart of Denise Darvall, the 25-year-old victim of a road accident.

Darvall's father had agreed to the procedure. In the operating theatre Friedmann leaned in to assess Washkansky on the table.

"I looked into this empty chest with no heart in it, a man lying there without a heart in his body and just a lung heart machine keeping him alive. It was very scary," she says.

In the room next door, Barnard ordered that Darvall's ventilator be turned off. After about 12 minutes her heart stopped beating and it was quickly moved to the theatre where 53-year-old Washkansky awaited it.

"There were still a lot of medical ethics issues. It was the first time time that a heart transplant was being done... and he did not want anybody to be able to say we took out a beating heart from a patient," Friedmann says of Barnard, who died in 2001.

"There was a feeling of nervousness: is this heart going to beat and take over the circulation? When it started, it was so exciting, so wonderful."

'The rhythm of life'

Barnard, then 45, said of the operation: "The heart lay paralysed, without any sign of life. We waited -- it seemed like hours -- until it slowly began to relax. Then it came like a bolt of light.

"There was a sudden contraction of the atria, followed quickly by the ventricles in obedient response. Little by little it began to roll with the lovely rhythm of life."

Coming as it did during the apartheid years race became a consideration when selecting a donor, but only to avoid allegations of prejudice.

The pioneering operation could in fact have been performed weeks earlier, when a coloured man's heart became available.

"Professor Barnard had decided that the first donor had to be a white person, because of the apartheid. We did not want anyone to say 'You are taking out a black person's heart to put it in a white patient'" says Friedmann.

She also squashed the rumour that persists about a black South African, Hamilton Naki, participating in the first transplant but that he was deprived by the apartheid government of any recognition.

"He was very talented, but he never operated on patients," says Friedmann, who worked with Naki on many laboratory tests on dogs.

Just 18 days after the world first of the Washkansky operation, the patient died. The autopsy revealed that his lungs gave out, but not the heart, because his immune system had collapsed, resulting in pneumonia.

Today, a heart transplant -- while still a high-risk procedure -- no longer makes headlines.

Around 3,500 transplants are carried out each year, of which about 2,000 are in the United States.

About 88 percent of patients survive the first year after surgery, 75 percent survive for five years, and 56 percent 10 years after the operation, according to the US National Heart, Lung, and Blood Institute (NHLBI).

The world's first organ transplants

Fifty years after the first heart transplant in South Africa, here is look back over the history of human organ transplants.

The discovery of the immunosuppressive effects of cyclosporine, derived from a microscopic fungus, gave new impetus to transplants from the early 1980s, greatly reducing the risks of organ rejection.

Skin

In November 1869 Swiss doctor Jacques-Louis Reverdin carries out in Paris the first modern skin transplant. He covers a wound on a patient's left elbow with skin taken from their right arm.

Kidney

In June 1950 in the US city of Chicago, doctor Richard Lawler transplants the kidney of a deceased person into a woman. The organ is rejected after 10 months but the patient survives for five years.

Two years later in Paris, the team of Jean Hamburger carries out the first kidney transplant from a living donor. The patient dies 21 days later.

Liver

In 1963 in the US city of Denver, Thomas Starzl attempts the first liver transplant but the three-year-old patient dies.

The professor is more successful in 1967 when the 19-month-old organ recipient survives for more than a year.

Lung

The first lung transplant is carried out in June 1963 in Jackson, United States, by James Hardy. The patient survives 18 days.

Heart

Christiaan Barnard carries out the first human-to-human heart transplant in December 1967 in Cape Town. The patient survives 18 days but dies from pneumonia.

The first transplant with an artificial heart is carried out in December 1982 in Salt Lake City in the United States. The patient survives 122 days.

Larynx

In January 1998 in Cleveland, United States, a successful larynx transplant is carried out on a man who has lost his vocal cords in a motorcycle accident. It is only made public in 2001.

Hand

In September 1998 at Lyon, France, the team of Professor Jean-Michel Dubernard transplants a donor's hand on to a 47-year-old New Zealander. It is amputated in February 2001 after the patient abandons his anti-rejection treatment.

In January 2000 a transplant of a patient's two hands and the lower part of his forearms is carried out by Dubernard.

Tongue

The first successful tongue transplant is carried out in July 2003 in Vienna on a person suffering from mouth cancer.

Face

In November 2005 in Amiens, France, a partial face transplant involving nose, lips and chin is carried out on a woman disfigured by her dog, by the team of Dubernard and Bernard Devauchelle.

In March 2010 in Barcelona, Spain, a group led by Joan Pere Barret carries out the first successful complete face transplant on a man deformed in an accident.

In August 2015 in New York the team of Professor Eduardo Rodriguez carries out a complete face transplant including the scalp, ears and ear ducts. It is considered the most comprehensive face transplant to date.

Penis

In September 2006, the first penis transplant is successfully carried out in China on a 44-year-old man. Two weeks later, he asks for the organ to be removed due to psychological trauma.

Uterus

In September 2014 in Gothenburg, Sweden, a woman gives birth to a baby after receiving a uterus transplant, in a new first.